Glenohumeral osteoarthritis (OA) is a common condition typically associated with increasing age and often previous trauma. Patients typically present in later stages with generalized shoulder pain due to degeneration of articular cartilage with limited active and passive range of motion as a result of capsular contractures. There are many potential causes of glenohumeral OA (e.g., posttraumatic or iatrogenic); however, the majority of cases are idiopathic in nature.
Although glenohumeral OA is most commonly observed in the aging population, younger patients can still be afflicted with the condition. As a referral practice, we have seen a particularly large number of younger patients (e.g., <60 years of age) with glenohumeral OA who prefer to either avoid or delay arthroplasty using a joint- preserving approach.
The rationale to pursue joint preservation is based upon the limitations and risks currently associatedwithtotalshoulderarthroplasty(TSA) in young patients. Specifically, it is well known that the clinical outcomes and patient satisfaction following TSA are less favorable in patients younger than 50 years of age. This effect is perhaps due to the fact that younger patients are more likely to engage in higher-demand activities and are generally more active. Due to limited implant longevity, TSA in younger patients may necessitate revision TSA which, in itself, is also known to produce less optimal outcomes when compared to primary TSA. Thus, the risk for failure after TSA is particularly elevated in those who participate in higher-demand activities which may accelerate polyethylene wear and lead to implant loosening.
Arthroscopic joint preservation is considered a palliative measure designed to address known and treatable pain generators in the shoulder in order to alleviate symptoms and either delay or prevent the need for future arthroplasty. The comprehensive arthroscopic management (CAM) procedure involves glenohumeral debridement and chondroplasty, humeral head osteoplasty, capsular releases, and axillary nerve neurolysis. Microfracture, subacromial decompression with or without acromioplasty, and biceps tenodesis are also performed when necessary. Preliminary results of this procedure have been encouraging. The purpose of this chapter is to describe and illustrate the CAM procedure in detail and to review the clinical results following arthroscopic joint-preserving approaches for glenohumeral OA.